The Impact of Pain on Work Participation The Impact of Pain on Work Participation Michiel Reneman Center for Rehabilitation / Rehabilitation Medicine Spine Center
Focus of this contribution Chronic non-specific musculoskeletal pain (CMP) Because: Largest subgroup of people with pain Most costly, because of work productivity loss
Outline 1. Impact of pain on work 2. Impact of work on health and well-being 3. Staying at work with pain 4. Treatment options 5. Concluding remarks
LBP: Low Back Pain LBP highly common among the general population ~ 90% at least once in adult life Often full recovery in weeks Recurrent 44-78% relapse of pain 26-37% relapse of work absence Few: chronic pain with significant limitations in ADL and work
Societal costs Direct: costs related to medical care Medical: medical, allied, complimentary, … • Nonmedical: transportation, meals, house renovations • Indirect: costs related to consequences of CLBP Absenteeism • Temporary / permanent / modified hours / modified work / • modified shifts / … Presenteeism • present, but less productive • Disability • Replacement: overtime, recruitment, training • Household productivity: replacement by partner or outsider • Intangible costs: decreased QoL (often not included) •
Direct and indirect costs 9 countries; various methods Direct costs: mean 22% Indirect costs: mean 78% USA: LBP 6 th costliest health condition, 3 rd in associated disability NL: 0.6% - 0.9% GNP … by any standards must be considered a substantial burden on society
Outline 1. Impact of pain on work 2. Impact of work on health and well-being 3. Staying at work with pain 4. Treatment options 5. Concluding remarks
Impact of work on health and well-being Independent review, 'Is Work Good for Your Health and Well- being?‘ Commissioned by the UK Department for Work and Pensions Examination of scientific evidence on the health benefits of work, focusing on adults of working age and the common health problems that account for two-thirds of sickness absence and long-term incapacity.
Impact of work on health and well-being There is strong evidence showing that work is generally good for physical and mental health and well- being. … That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries. The provisors are … jobs must be safe and accommodating. Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long- term unemployment or prolonged sickness absence. Work is generally good for health and well- being.’ Waddell en Burton, 2006
Outline 1. Impact of pain on work 2. Impact of work on health and well-being 3. Staying at work with pain 4. Treatment options 5. Concluding remarks
Relevance: – ‘Unknown’ in literature – New reference field – What can we and our patients learn from them? – What goes right?
The SAW study Systematic review of scientific literature In-depth interviews with participants N=120 workers with chronic pain, < 5% absenteeism Measurements: Bio: functional capacity, • aerobic capacity, activities Psycho: cognitions, emotions, • distress, coping, … etc Social: occupational physician, • boss, partner
Systematic review: determinants for SAW? Consistent (low level) evidence Inconsistent evidence: • low emotional distress SAW • self-efficacy • low physical disability SAW • age • duration of pain n.s. • gender • catastrophizing n.s. • educational level • self-esteem n.s. • physical and mental health • marital status n.s. • pain intensity • depressive symptoms • coping Conclusion • High level evidence for determinants for SAW is absent • Existing knowledge is based on low level of evidence
In-depth interviews – why and how? To explore Motivators: why SAW with chronic pain? Success factors: how are they able to SAW? Motivators: Success factors: • work as life value • personality traits • work as income • adjustment latitude • work as responsibility • coping with pain • work as therapy • use healthcare services • pain beliefs
An attempt to quantify presenteeism in the SAW study Preliminary results Two questionnaires: 0-100% - higher is more productive Work Ability Index (WAI) Current work ability: 71% • Health and Productivity Questionnaire (HPQ) Work productivity past 4 weeks: 77% • Work productivity past 2 years: 78% •
Preliminary comparison Workers with CMP: n=120 absent / n=120 SAW Larger differences (ES>0.5) Pain disability, physical and mental health, lifting, static • overhead work and forward bending, pain catastrophizing, pain self-efficacy, work satisfaction Smaller / no differences (ES<0.5) Pain intensity, activity level, dynamic bending, pain • acceptance, fear avoidance beliefs, psycho-neuroticism, pain coping, responses of significant others, need for recovery, and work demands
Final results expected fall 2012 The results can be used to develop interventions to promote SAW. New positive reference Patients • Clinicians: pain-, rehabilitation, occupational, and • insurance medicine
Outline 1. Impact of pain on work 2. Impact of work on health and well-being 3. Staying at work with pain 4. Treatment options 5. Concluding remarks
Evidence based treatment options European guidelines for the management of LBP COST B13 Working Group Published: www.backpaineurope.org European Spine Journal – 2006 1. Chronic 2. Prevention
EB treatment options for CHRONIC LBP Low disability simple EB therapies may be sufficient • Exercises, brief interventions, medication • Substantial disability … due to its multidimensional nature, no single intervention • is likely to be effective in treatment of overall problem of CLBP Most promising Cognitive / behavioral and encouraging exercise /activity • = multidisciplinary rehabilitation •
Rehabilitation: effective and cost-effective Systematic reviews: Multidisciplinary vocational rehabilitation effective for patients with chronic musculoskeletal pain • Less disability • More work participation • Increase quality of life • Cost effective at follow up
Current and future challenges Average size of the effects moderate Working ingredients of pain rehab largely unknown • What works for whom? • Who works for whom? • How much / how long? Personal note: • bioPSYCHOsocial BIOPSYCHOSOCIAL • Collaboration and crossover: rehab – anesthesiology – occupational
Evidence based options for PREVENTION of LBP Overarching comments: Limited robust evidence for incidence (first time onset) Primary mechanisms causing LBP largely undetermined Evidence that prevention of various consequences is feasible Physical activity and appropriate education One educational strategy: media campaigns aimed at the general public
Public education Basic assumption: beliefs guide behaviors LBP beliefs: serious pathology needs rest to heal Public education to changing this belief has been focus of public campaigns Messages: be active, stay at work (modified) Australia, Canada, Norway, Scotland Netherlands: preparations Other European countries???
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Outline 1. Impact of pain on work 2. Impact of work on health and well-being 3. Staying at work with pain 4. Treatment options 5. Concluding remarks
Concluding remarks 1. Impact of pain on work Substantial impact on work and society 2. Impact of work on health and well-being Overall, work contributes to health and well-being 3. Staying at work with pain It can be done, but very limited knowledge on Why and How 4. Treatment options Chronic: rehabilitation, but effect sizes modest Prevention work disability feasible: public education
Thank you Thank you Michiel Reneman Center for Rehabilitation / Rehabilitation Medicine Spine Center
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